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Thank for your interest in factoring your invoices through our company. You may complete this form online for more information or click on the "Download Forms" button to the left and download the factoring form and Email it to All information will be kept in the strictest of confidence.

Bold fields are required:
Company Name


Legal Name


Federal Tax ID#


Contact Name


Company Address


Mailing Address




Fax Number


Business Type


Business Structure


State / Date Formed


Liens on Invoices?


Terms of Sale


Number of Customers


Number of Invoices


Average Invoices Amt


Last Year Sales


Projected Sales




Payroll Taxes Current?


Federal / State Taxes


Intent to Levy?


Judgments / Liens / Lawsuits


Loans Yes or No


Factored Before?


Financing Needed


Additional Comments


List Current / Future Customers


Company Principals / Officers


The foregoing statements and information  given above is true and correct to the best of my / our knowledge and is given to Diversified CashFlow Funding to induce funding source(s) to consider entering into a factoring agreement with the above company. I / we grant the Funding Source(s) of Diversified Cashflow Funding to verify and investigate all of the above statements and to review my / our credit report(s).  The information submitted does not exclude any information relevant to the financial condition of this company / principal owner.

I am an authorized agent of this company.





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